Healthcare Provider Details

I. General information

NPI: 1891323648
Provider Name (Legal Business Name): RYAN ANDREW CHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

IV. Provider business mailing address

39000 BOB HOPE DR
RANCHO MIRAGE CA
92270-3202
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-3564
  • Fax: 760-773-1605
Mailing address:
  • Phone: 760-834-3564
  • Fax: 760-773-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA188022
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA188022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: